tetano
Editor, Senior Moderator
Respirology
. 2022 Aug 7.
doi: 10.1111/resp.14336. Online ahead of print.
Breath-holding physiology, radiological severity and adverse outcomes in COVID-19 patients: A prospective validation study
Ludovico Messineo[SUP] 1 [/SUP], Francesco Fanfulla[SUP] 2 [/SUP], Leonardo Pedroni[SUP] 3 [/SUP], Floriana Pini[SUP] 4 [/SUP], Andrea Borghesi[SUP] 5 [/SUP], Salvatore Golemi[SUP] 5 [/SUP], Guido Vailati[SUP] 3 [/SUP], Kayla Kerlin[SUP] 1 [/SUP], Atul Malhotra[SUP] 6 [/SUP], Luciano Corda[SUP] 3 7 [/SUP], Scott Sands[SUP] 1 8 [/SUP]
Affiliations
Abstract
Background and objective: COVID-19 remains a major cause of respiratory failure, and means to identify future deterioration is needed. We recently developed a prediction score based on breath-holding manoeuvres (desaturation and maximal duration) to predict incident adverse COVID-19 outcomes. Here we prospectively validated our breath-holding prediction score in COVID-19 patients, and assessed associations with radiological scores of pulmonary involvement.
Methods: Hospitalized COVID-19 patients (N = 110, three recruitment centres) performed breath-holds at admission to provide a prediction score (Messineo et al.) based on mean desaturation (20-s breath-holds) and maximal breath-hold duration, plus baseline saturation, body mass index and cardiovascular disease. Odds ratios for incident adverse outcomes (composite of bi-level ventilatory support, ICU admission and death) were described for patients with versus without elevated scores (>0). Regression examined associations with chest x-ray (Brixia score) and computed tomography (CT; 3D-software quantification). Additional comparisons were made with the previously-validated '4C-score'.
Results: Elevated prediction score was associated with adverse COVID-19 outcomes (N = 12/110), OR[95%CI] = 4.54[1.17-17.83], p = 0.030 (positive predictive value = 9/48, negative predictive value = 59/62). Results were diminished with removal of mean desaturation from the prediction score (OR = 3.30[0.93-11.72]). The prediction score rose linearly with Brixia score (β[95%CI] = 0.13[0.02-0.23], p = 0.026, N = 103) and CT-based quantification (β = 1.02[0.39-1.65], p = 0.002, N = 45). Mean desaturation was also associated with both radiological assessment. Elevated 4C-scores (≥high-risk category) had a weaker association with adverse outcomes (OR = 2.44[0.62-9.56]).
Conclusion: An elevated breath-holding prediction score is associated with almost five-fold increased adverse COVID-19 outcome risk, and with pulmonary deficits observed in chest imaging. Breath-holding may identify COVID-19 patients at risk of future respiratory failure.
Keywords: COVID-19; breath-holding procedure; coronavirus disease; incident adverse outcome; mean desaturation; physiology; radiological severity.
. 2022 Aug 7.
doi: 10.1111/resp.14336. Online ahead of print.
Breath-holding physiology, radiological severity and adverse outcomes in COVID-19 patients: A prospective validation study
Ludovico Messineo[SUP] 1 [/SUP], Francesco Fanfulla[SUP] 2 [/SUP], Leonardo Pedroni[SUP] 3 [/SUP], Floriana Pini[SUP] 4 [/SUP], Andrea Borghesi[SUP] 5 [/SUP], Salvatore Golemi[SUP] 5 [/SUP], Guido Vailati[SUP] 3 [/SUP], Kayla Kerlin[SUP] 1 [/SUP], Atul Malhotra[SUP] 6 [/SUP], Luciano Corda[SUP] 3 7 [/SUP], Scott Sands[SUP] 1 8 [/SUP]
Affiliations
- PMID: 35933689
- DOI: 10.1111/resp.14336
Abstract
Background and objective: COVID-19 remains a major cause of respiratory failure, and means to identify future deterioration is needed. We recently developed a prediction score based on breath-holding manoeuvres (desaturation and maximal duration) to predict incident adverse COVID-19 outcomes. Here we prospectively validated our breath-holding prediction score in COVID-19 patients, and assessed associations with radiological scores of pulmonary involvement.
Methods: Hospitalized COVID-19 patients (N = 110, three recruitment centres) performed breath-holds at admission to provide a prediction score (Messineo et al.) based on mean desaturation (20-s breath-holds) and maximal breath-hold duration, plus baseline saturation, body mass index and cardiovascular disease. Odds ratios for incident adverse outcomes (composite of bi-level ventilatory support, ICU admission and death) were described for patients with versus without elevated scores (>0). Regression examined associations with chest x-ray (Brixia score) and computed tomography (CT; 3D-software quantification). Additional comparisons were made with the previously-validated '4C-score'.
Results: Elevated prediction score was associated with adverse COVID-19 outcomes (N = 12/110), OR[95%CI] = 4.54[1.17-17.83], p = 0.030 (positive predictive value = 9/48, negative predictive value = 59/62). Results were diminished with removal of mean desaturation from the prediction score (OR = 3.30[0.93-11.72]). The prediction score rose linearly with Brixia score (β[95%CI] = 0.13[0.02-0.23], p = 0.026, N = 103) and CT-based quantification (β = 1.02[0.39-1.65], p = 0.002, N = 45). Mean desaturation was also associated with both radiological assessment. Elevated 4C-scores (≥high-risk category) had a weaker association with adverse outcomes (OR = 2.44[0.62-9.56]).
Conclusion: An elevated breath-holding prediction score is associated with almost five-fold increased adverse COVID-19 outcome risk, and with pulmonary deficits observed in chest imaging. Breath-holding may identify COVID-19 patients at risk of future respiratory failure.
Keywords: COVID-19; breath-holding procedure; coronavirus disease; incident adverse outcome; mean desaturation; physiology; radiological severity.